Phytotherapeutic Approaches to Lower Bowel Disease: Part 1; Chronic Inflammatory Bowel Disease

Phytotherapeutic Approaches to Lower Bowel Disease: Part 1; Chronic Inflammatory Bowel Disease

The lower bowel, large intestine, or colon, measuring about 6 1/2 feet in an adult, is specially adapted for absorption of fluids from the stool and the forward movement of food wastes. The mucosal lining both absorbs fluids and some food particles, but also secretes lubricating mucus and is a mechanism for the excretion of substances from the blood stream into the gut.

The digestive function of the colon is carried out largely by bacteria. There may be over 3 lbs. of bacteria in a healthy colon and these ferment remaining carbohydrates, producing lactic acid, hydrogen, carbon dioxide and methane. The bacteria also convert remaining amino acids into simpler substances: indole, skatole, hydrogen sulfide, and fatty acids. The indole and skatole are carried off in the feces and give them their characteristic odor, and the rest are absorbed into the blood stream for transport to the liver. The bacteria also decompose bilirubin breakdown products into stercobilin which gives the feces their color and they produce vitamins K and B12. Healthy bowel flora is critical and can be promoted with the use of psyllium, garlic, and probiotics. Fructo-oligosaccahrides (complex fruit sugars) are the preferred food of many beneficial bacteria and a daily teaspoon of Slippery Elm powder stirred into water can be very helpful.

Many different strains of bacteria naturally occur in the colon, and when supplementing them it is important to take a broad spectrum product, ideally the supplement should include some or all of the following strains: Lactobacillus acidophilus, L. rhamnosus, L. casei, L. bulgaricus, Streptococcus thermophilus, Bifidobacterium bifidum, and B. longum.

Bowel disease comes for many reasons and in many forms. Generally full blown disease is preceded by years of dietary abuses and poor lifestyle habits with low grade symptoms of digestive disturbance including episodes of constipation or diarrhea, flatulence, belching, bloating and cramping. Attention to the fundamental dietary and lifestyle issues forms the foundation of the treatment plan.

Diseases of the colon may be inflammatory (Crohn's disease, ulcerative colitis, diverticulitis) or may be functional (constipation, diarrhoea, diverticulosis).

Chronic inflammatory bowel disease

In chronic inflammatory bowel disease there is a strong correlation with genetic markers in the blood and with auto-immune inflammatory disease elsewhere in the body. There are greatly increased levels of prostaglandins in the serum, stool, and enteric mucosa. In particular there is an increase in the levels of leukotrienes that are formed from arachidonic acid and which promote inflammation. The bowel flora is usually disturbed. This may impair nutrient absorption. In active ulcerative colitis there is a significant decrease in the amount of mucus produced in the colon as well as a reduction of the sulphur content of the mucus. Thus there is a deficiency of soothing, anti-inflammatory mucus and of antibacterial, vulnerary sulphur.

Crohn's Disease

This is also called regional enteritis and refers to a chronic patchy inflammation of the digestive tract anywhere from esophagus to anus, but most usually affecting the terminal ileum. Most cases of Crohn's disease occur between the ages of 20 and 40 years. It occurs about equally in men and women. Crohn's disease occurs mostly in white persons of Northern European and Anglo Saxon ethnic derivation. Caucasians are 5 times more likely to develop Crohn's disease than are blacks or orientals.

In the early stages of Crohn's disease there are tiny "aphthoid" ulcers of the mucosa with underlying nodules of lymphoid tissue. The inflammation progresses to involve all layers of the intestinal wall, especially the submucosal area. There is widespread lymphatic congestion around the gut and eventually the intestinal wall will become fibrotic. In advanced cases the transmural inflammation, deep ulceration, local edema and fibrosis may cause bowel obstruction. There are often sinuses and fistulas, the latter of which may lead to many complications as infected material spreads to other hollow organs or to the peritoneal cavity.

The primary presenting symptoms are chronic diarrhoea (rarely with blood in the stool), flatulence, low grade fever, loss of appetite and weight, malaise and a feeling of fullness or sometimes crampy pain in the left iliac fossa. The symptoms frequently remit and recur over many months or years, but each relapse tends to be longer and more severe than the preceding one. Occasionally the patient will present with an acute onset of disease manifesting as intestinal obstruction, peritonitis or other forms of the `acute abdomen'.

Ulcerative Colitis

This refers to an episodic inflammation of the mucosal lining of the colon or rectum. The most common age of presentation is between 15 and 30 years although another small peak in incidence occurs between 50 and 70 years. The etiology of ulcerative colitis is unclear but it may be associated with infection, allergy, auto-immune disorders, and psychogenic factors. It often co-exists with Crohn's disease and the etiology may overlap.

The pathological presentation is of a continuous area of inflammation in the colon, causing the mucosa to be swollen and red. Ulceration may be deep or superficial, hut is widespread, causing sloughing off of mucosa and exposure of unprotected cells. Inflammation usually begins in the rectosigmoid area and spreads upwards into the descending, transverse and ascending colon.

The presenting symptom is usually chronic diarrhea with varying degrees of blood and mucus in the stool. Some mild lower abdominal pain is also common. Such attacks will come and go hut, like Crohn's disease, each one tends to be worse than the one before. If the ulceration is confined to only the rectum or sigmoid colon then the stools may be normal hut there will also be rectal loss of mucus with or between bowel movements.

There may be an occasional acute onset of ulcerative colitis. The person will present with sudden violent diarrhea, high fever, signs of peritonitis and profound toxemia. This is a medical emergency and the person should be taken to hospital immediately.

Holistic treatment of chronic inflammatory bowel disease

Malnutrition is very common in inflammatory bowel disease. The severity will depend on the severity and duration of attacks. There are a number of possible reasons for this malnutrition which include:

- Loss of appetite and hence reduced intake of food.

- Diarrhea allowing insufficient time for absorption.

- Decreased absorptive surfaces due to the disease process.

- Bacterial overgrowth and imbalance.

- Increased secretions in to the gut lumen leading to electrolyte and mineral loss in the stool.

- Increased intestinal cell turnover and thus increased protein requirements.

- Increased requirements of certain nutrients such as the essential fatty acids.

- Certain drugs such as corticosteroids and cholestyramine.

- Insufficiency of bile salts following surgical intervention.

- Malabsorption syndrome.

The nutritional approach to the treatment of inflammatory bowel disease is initially to use a modified cleansing program. Often symptoms of pain and abdominal discomfort are minimized by avoiding foods so, as long as the person is not too debilitated, then 2 or 3 days of mono food fasting would be ideal. Apples are excellent because the pectin content will soothe and protect the mucosal lining at the same time as acting as a gently bulking agent to give form and substance to the stool. Vegetable juices or brown rice are other useful fasting foods in this situation.

Garlic should be taken in high doses during the fast. At least three cloves per day and more if the person can tolerate them. Fresh raw garlic should be used. This will promote healing, reduce inflammation and balance the bowel flora. Slippery elm gruel can also be taken to soothe the inflamed tissues and promote healing.

Following the fast it is a good time to do allergy testing. The foods that are reintroduced into the diet will depend upon the individual tolerances. If it does not irritate the intestines then the person can go on to several days of raw foods then part raw and part cooked. If the digestive system is very sensitive then vegetable broth is the best food to break the fast with, several bowls per day for two days before eating any solid foods.

Every two weeks the person should do a one day water fast to allow the mucus membranes to cleanse and regenerate. On the night before the fast and in the morning and evening of the fast the person should take two or three chopped cloves of garlic with two teaspoons of slippery elm powder in water.

It is important to emphasize the role of food allergies in the treatment of chronic inflammatory bowel disease. Lactose intolerance and frank allergy to milk protein is common and all dairy products should be strictly avoided for at least one month to assess the impact of this. Many patients achieve significant improvement from complete avoidance of all grains and cereals. This may be due to impaired digestive ability leading to passage of partially digested carbohydrate into the bowel where it causes disturbance in the bowel flora, or may be due to a more classical allergy. A book by Elaine Gottschall called `Breaking the Vicious Cycle' can be helpful in guiding the patient through this process of grain and carbohydrate elimination. (See the accompanying article entitled Constitutional Food Intolerance on page seven.

Due to the impaired digestive ability and rapid transit time, many nutrients may be poorly absorbed and sub-clinical malnutrition is common. The fat soluble vitamins are particularly at risk of poor absorption. A comprehensive supplement program is helpful to ensure adequate supply of essential nutrients. For improved absorption it is ideal to take supplements in liquid form. lf these are not readily available try crushing tablets and opening capsules. A basic protective program will include:

- Zinc30 - 50 mg daily

- Folic acid800 mcg daily

- B 12800 mcg daily

- Beta carotene20,000 iu daily

- Glutamineup to 4 grams daily

- Vitamin C2 grams daily (buffered form)

- Vitamin E800 iu daily

- Calcium citrate500 mg daily

- Magnesium citrate500 mg daily

- Evening Primrose oil3 grams daily

- Digestive enzymes1 - 2 capsules after each meal (broad spectrum)

- Gamma oryzanol500 mg daily

- N-acetyl-glucosamine1500 mg daily

Herbal remedies

Herbal formulas to treat inflammatory bowel disease incorporate anti-inflammatory, astringent, demulcent, mucosal tonic, and immune enhancing herbs, with the formula adjusted according to the presenting symptoms of the patient.

Anti-inflammatories

These are herbs which reduce the inflammatory processes by a variety of mechanisms. The may soothe the irritated mucus membranes by coating them with mucilage, regulate the fatty acid - prostaglandin cascade, improve circulation to the affected area and regulate the functions of cortisol and the actions of the immune system.

Chamomilla recutita (Chamomile)

Calendula officinalis (Marigold)

Salix alba/nigra (Black/White Willow)

Filipendula ulnaria (Meadowsweet)

Dioscorea villosa (Wild Yam)

Glycyrrhiza glabra (Licorice)

Harpagophytum procumbens (Devil's Claw)

Althea officinalis (Marshmallow)

Ulmus fulvus (Slippery elm)

Curcuma longa (Turmeric)

Astringents

Herbs that tone and tighten the lining of the gut and prevent bleeding or fluid loss. They all contain tannins which are antibacterial, anti-viral and anti-inflammatory. Astringents with a tissue specificity for the bowel include

Agrimonia eupatoria (Agrimony)

Quercus alba / rubra (White / Red Oak)

Geranium maculatum (Cranesbill)

Geranium robertianum (Herb Robert)

Potentilla spp. (Tormentil)

Capsella bursa-pastoris (Shepherd's Purse)

Rubus ideaus (Red raspberry)

Geum urbanum (Avens)

Demulcents

These are herbs especially rich in mucilage that can soothe and protect irritated or inflamed tissues. They area type of anti-inflammatory and are somewhat vulnerary (healing) as well.

Symphytum off. (Comfrey)

Althea off. (Marshmallow)

Ulmus fulvus (Slippery Elm)

Mucosal tonics and regeneratives

These are herbs which nourish and strengthen the mucosal lining and improve its integrity. They combine very well with the use of N-acetyl-glucosamine which improves the quality and regulates the quantity of mucus being produced.

Centella asiatica (Gotu kola)

Plantago lanceolata / major (Plantian)

Hydrastis canadensis (Goldenseal)

When treating ulcerative colitis and Crohn's disease it is important to remember that they can be significantly affected by stress factors. Most patients will tell you that the symptoms are much worse when they are under stress so you should encourage the person to practice stress reduction techniques and possibly to take nervine herbs.

Psyllium may be used freely (1-2teaspoon stirred into cold water once or twice a day on an empty stomach). This will give form and bulk to the stool. The high fibre content may bind some minerals and make them unavailable for absorption so it is best taken on an empty stomach.

Exercise is useful to reduce stress and maintain general levels of wellness. Exercise such as walking, cycling, or dancing that encourages blood flow in the pelvis may be beneficial.

Example formula for ulcerative colitis

Calendula off. (Marigold)

YouTube video:

2 parts

anti-inflammatory, immune stimulant,

bitter alterative, lymphatic stimulant

vulnerary

Geum urbanum (Avens)

1 part

astringent

Glycyrrhiza glabra (Licorice)

1 part

anti-inflammatory, immune supporting,

adaptogenic

Centella asiatica (Gotu kola)

1 part

mucosal tonic

Dioscorea villosa (Wild yam)

1 part

anti-inflammatory

Althea off. (Marshmallow)

1 part

soothing demulcent

Hydrastis canadensis (Goldenseal)

1 part

mucus membrane tonic, bitter,

antibacterial

For Crohn's disease

Chamomilla recutita (Chamomile)

2 parts

bitter, anti-inflammatory, anti-allergenic,

relaxing nervine

Ceanothus americanum (Red root)

1 part

lymphatic and tissue decongestant,

immune support

Achillea millefolium (Yarrow)

1 part

pelvic decongestant, astringent, bitter

Glycyrrhiza glabra (Licorice)

1 part

anti-inflammatory, immune supporting,

adaptogenic

Centella asiatica (Gotu kola)

1 part

mucosal tonic

Plantago lanceolata (Plantain)

1 part

mucosal tonic, astringent, vulnerary

Medical Herbalism.

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By Chanchal Cabrera

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